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PROVIDENCE HEALTH & SERVICES - OREGON
NPI 1104246008
Clinic/Center in Portland, OR

Active since April 18, 2014
18040 SW LOWER BOONES FERRY RD, SUITE 104, PORTLAND, OR 97224(855) 229-6490 Get Directions Write a Review

NPPES record last updated: June 20, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 20, 2025, May 16, 2025 (2 updates tracked since 2025).

About Providence Health & Services - Oregon NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE HEALTH & SERVICES - OREGON (NPI 1104246008), doing business as Providence Medical Group, is a healthcare organization registered as a clinic/center in Portland, Oregon and active in the NPI registry since April 2014. The organization lists Keenan B Freeman, Cfo, as its authorized official.

NPPES Registry Identity

NPI1104246008
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NamePROVIDENCE HEALTH & SERVICES - OREGON
Location Address18040 SW LOWER BOONES FERRY RD, SUITE 104Portland, OR 97224-7259
Mailing AddressPo Box 31001 - 4180Pasadena, CA 91110-4180
Phone(855) 229-6490
Organization SubpartNo
Authorized OfficialKeenan B FreemanCfo · (503) 893-6524
Enumeration DateApril 18, 2014
Last NPPES UpdateJune 20, 20252 updates tracked since enumeration
NPPES CertifiedJune 20, 2025
✔ NPI 1104246008 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
18040 SW LOWER BOONES FERRY RD, Portland, OR 97224
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Other Names 2

Doing Business AsProvidence Medical Group
Doing Business AsProvidence Health Express At Bridgeport

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDREW DAVID BODMER PA-C
Physician Assistant
18040 SW LOWER BOONES FERRY RD, SUITE 100
TIGARD, OR 97224
Washington County (503) 216-0700
KENRIC BRION CRAVER PA
Physician Assistant
18040 SW LOWER BOONES FERRY RD
TIGARD, OR 97224
Washington County (503) 216-0700
EMILY JUNE PUUKKA CLARK MD
Family Medicine
18040 SW LOWER BOONES FERRY RD, STE 100
TIGARD, OR 97224
Washington County (503) 216-0700
JOHN H SCHWARTZ MD
Family Medicine
18040 SW LOWER BOONES FERRY RD, SUITE 100
TIGARD, OR 97224
Washington County (503) 216-0700
PROVIDENCE HEALTH & SERVICES OREGON
Clinic/Center
18040 SW LOWER BOONES FERRY RD, SUITE 207
TIGARD, OR 97224
Washington County (503) 215-5340
BHAVESH RAJANI MD
Family Medicine
18040 SW LOWER BOONES FERRY RD, STE 100
TIGARD, OR 97224
Washington County (503) 216-0700
MRS. LISA ROSE LUNDIN RPH
Pharmacist
18040 SW LOWER BOONES FERRY RD
TIGARD, OR 97224
Washington County (503) 216-0625
JESSICA N MEHTA MD
Dermatology
18040 SW LOWER BOONES FERRY RD, SUITE 100
TIGARD, OR 97224
Washington County (503) 216-0770

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Health & Services - Oregon's NPI number?

The NPI number for Providence Health & Services - Oregon is 1104246008. It was assigned to this organization in the NPPES registry on April 18, 2014. The provider is doing business as Providence Medical Group and Providence Health Express at Bridgeport.

Where is Providence Health & Services - Oregon located?

Providence Health & Services - Oregon is located at 18040 SW Lower Boones Ferry Rd Suite 104, Portland, OR 97224. The listed phone number is (855) 229-6490.

What is Providence Health & Services - Oregon's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

When was this NPI record last updated?

The NPPES record for Providence Health & Services - Oregon was last updated on June 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.